New North Carolina Law Expands Licensure Flexibility for Health Care Providers

On July 1, 2025, Governor Josh Stein signed into law House Bill 67 (Session Law 2025-37), an Act to Enact Healthcare Workforce Reforms for the State of North Carolina, which makes the most significant updates in years to how North Carolina licenses and regulates health care professionals.

The changes are designed to make it easier to bring physicians, physician assistants, pharmacists and psychological associates into the workforce, while also expanding what certain providers can do in practice. For health care organizations, especially rural practices, these reforms could help ease staffing shortages, expand care delivery and reduce administrative hurdles.

Key Takeaways 

• Easier physician recruitment. North Carolina joins the Interstate Medical Licensure Compact (effective Jan. 1, 2026), offering a fast-track for out-of-state physicians.
• Practice changes for physician assistants. North Carolina adopts a PA licensure compact and introduces “team-based practice” options with reduced administrative requirements.
• New license for internationally-trained doctors. Rural practices and hospitals can hire physicians under a limited license that can convert to full licensure after four years.
• Expanded pharmacist authority. Clinical pharmacists may now order/administer certain tests and provide broader care under collaborative agreements.
• Increased independence for psychological associates. With enough supervised hours, psychological associates may practice without direct supervision.

What These Changes Mean in Detail

While the key points highlight the big picture, the law contains several specific provisions with different timelines and requirements. Below is a closer look at the most notable reforms, when they take effect, and what they could mean for your practice.

1. Interstate Medical Licensure Compact. Effective January 1, 2026, North Carolina is authorized to join the large majority of other U.S. States in the Interstate Medical Licensure Compact. The Compact provides an expedited pathway for physicians in other Compact states to become licensed in North Carolina, and also provides a corresponding path for North Carolina-licensed physicians to become reciprocally licensed in other Compact states. To be eligible, a physician must have a full, unrestricted medical license in another Compact state, meet certain residency and practice requirements in their home state, and satisfy certain other requirements. Of North Carolina’s neighbors, Tennessee and Georgia are Compact members, but Virginia and South Carolina are not. North Carolina’s adoption of the Interstate Medical Licensure Compact will provide physicians with a streamlined process for becoming licensed in multiple states, thereby enhancing the portability of a medical license and improving patient care and access. This will facilitate recruitment to practices and also provides a more ready opportunity for North Carolina physicians to move to other Compact states.
2. Physician Assistant Interstate Licensure Compact. North Carolina’s adoption of a new Physician Assistant Licensure Compact similarly offers accelerated pathways for physician assistant licensure in North Carolina and for North Carolina-licensed physician assistants to more easily practice in other Compact states. The law establishes a Licensure Compact Commission led by representatives from each Compact state to administer the Compact, as well as a coordinated data and reporting system to streamline licensure functions between Compact states. While theCompact will serve as an expedited alternative for licensure of physician assistants from Compact states, it will not replace existing licensure pathways in North Carolina. The effective date of this portion of the law is delayed pending the Compact becoming active in a sufficient number of states under the statute.
3. Internationally-Trained Physician Employee Licensee.[1] Effective January 1, 2026, North Carolina may issue a new type of limited physician license: an “Internationally-Trained Physician Employee Licensee.” This limited license will be available to internationally trained physicians who have an offer of full-time employment at a North Carolina licensed hospital or a medical practice in a county with less than 500 people per square mile, if another North Carolina licensed physician is also physically practicing on-site. Most North Carolina counties qualify as “rural” under this definition (currently 91 of the 100).[2]  The physician must meet certain competency and educational requirements, including eligibility to be certified by the Educational Commission for Foreign Medical Graduates. The physician is eligible for a full license after four years. Similar to the Compact, this will assist in recruiting new physicians to North Carolina, particularly for any of the 91 non-urban counties.
4. Pharmacist Collaborative Practice.    Effective October 1, 2025, clinical pharmacist practitioners may provide certain drug therapy, disease, and population health services under collaborative practice agreements with physicians licensed in North Carolina. Clinical pharmacist practitioners providing services under these collaborative arrangements must have site-specific supervising physicians who conduct periodic review and evaluation of the services provided by clinical pharmacist practitioners. They must also enter into written agreements that address the health care services delegated to clinical pharmacist practitioners, which now can include ordering and administering flu tests.[3]Thus, eligible pharmacists will have an expanded scope of practice. This change aligns with existing supervisory frameworks in North Carolina for nurse practitioners and physician assistants and is intended to streamline the delivery of these services.
5. Physician Assistant Team-Based Practice. Effective the earlier of the North Carolina Medical Board’s adoption of permanent rules or June 30, 2026, physician assistants may practice under a team-based structure if certain criteria are met. This option will be available to physician assistants that practice in one of the following team-based settings: (1) medical practices that are owned by a majority of licensed physicians who participate in the design and provision of care to patients, and that include physicians and team-based physician assistants that work in the same clinical practice area, or (2) hospitals, clinics, nursing homes, and other health facilities where physicians have consistent and meaningful participation in the design and provision of care to patients. As such, the law views medical practices that foster collaboration between clinicians of the same specialty, including physicians and physician assistants, as appropriate for team-based practice, but not practices where physician assistants are not regularly interacting with physicians and other clinicians in their practice area.
   1. Team-based physician assistants must also have more than 4,000 hours of clinical practice experience as a licensed physician assistant and more than 1,000 hours of clinical practice experience within the specific medical specialty of practice with a physician in that specialty.
   2. Unlike other physician assistants, team-based physician assistants in general will not be required to submit supervising physician contact information to the Medical Board or to obtain written instructions and authorizations from supervising physicians for certain prescriptions.
   3. Team-based physician assistants that practice in perioperative settings, including those that provide surgical or anesthesia-related services, must be supervised by a physician. In addition, medical practices that specialize in pain management are entirely excluded from qualifying as team-based settings.
6. Psychological Associate Practice Flexibilities. Effective October 1, 2025, licensed psychological associates may engage in independent practice without supervision by a psychologist or qualified psychological associate if they have 4,000 hours of post-licensure experience in the delivery of psychological services under such supervision within a time period of at least 24 consecutive months or less than 60 consecutive months. Performance ratings for qualifying psychological associates during those time periods must have been average or above average. The law also provides new parameters for psychological associates seeking to practice neuropsychology or forensic psychology, requiring those providers to demonstrate specialized education and training to the North Carolina Psychology Board prior to practicing in those specialties.

Preparing Your Practice

Providers should evaluate how these reforms may affect staffing, recruitment and supervision needs. This includes:

• Assessing recruitment strategies to take advantage of new licensure pathways for physicians and PAs.
• Reviewing supervision structures for pharmacists, physician assistants and psychological associates to ensure compliance with the new flexibilities.
• Updating policies and procedures around collaborative practice agreements and team-based care models.
• Planning for rural coverage opportunities, particularly with the new limited license for internationally trained physicians.

By acting early, practices can position themselves to recruit more efficiently, expand care delivery and reduce administrative burdens as these reforms take effect.

If you have questions about these reforms, please contact Josiah Irvin, John Gibson, Robert Shaw or the Smith Anderson lawyer with whom you currently work.

This article was first published by The Carolinas Medical Group Management Association on September 24, 2025.

[1] The North Carolina Medical Board has FAQs on this new limited licensure category - https://www.ncmedboard.org/resources-information/faqs/professional-faqs/special-topics.

[2] Only Mecklenburg, Wake, New Hanover, Durham, Forsyth, Guilford, Cabarrus, Gaston, and Cumberland are too dense to qualify.

[3] Following the State Health Director issuing a standing order permitting the same, which is required no later than October 1, 2025.